门静脉海绵样变性三维动态增强磁共振血管成像的诊断及其价值  

Value of 3D-DCE MRA in diagnosis of cavernous transformation of portal vein

作　　者：葛玲玉[1] 严森祥[1] 许顺良[1] 黄强[1] 商德胜[1] 

机构地区：[1]浙江大学医学院附属第一医院放射科,浙江杭州310003

出　　处：《浙江大学学报（医学版）》2008年第2期203-207,共5页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的:分析门静脉海绵样变性(Cavernous transformation of the portal ven CTPV)三维动态增强磁共振血管成像的表现和特征,探讨对本病诊断及其价值。方法:回顾性分析了24例门静脉海绵样变的磁共振血管成像的图像,观察了其特征性的磁共振门静脉成像的表现,所有病例均经临床、实验室及彩超检查,其中14例经手术治疗,2例肝癌门脉主干癌栓伴CTPV患者行肝动脉化疗栓塞术。结果:本组24例CTPV以门静脉主干CTPV为主10例,门静脉主干及左右支均受累者8例,单纯左支或右支4例,肠系膜上静脉水平发生者2例。9例门静脉成像清楚地显示,数条迂曲的侧支循环静脉跨过阻塞部位向肝内匐形延伸,其中7例可在网状、管状扩张的门静脉内见细条状、小点状低信号的栓子,6例清楚地显示,门静脉全程多条细小迂曲的侧支循环静脉缠绕在一起,扭曲成网状血管结构的影像,其它15例见离肝性侧支循环静脉走行、分布情况。结论:三维动态增强磁共振血管成像能准确地提供CTPV位置、严重程度的信息,可直观地评价CTPV,为临床采取正确的治疗措施提供更多有重要价值的信息。Objective： To evaluate three dimensional dynamic contrast-enhanced magnetic resonance angiography （3D-DCE MRA） in diagnosis of cavernous transformation of portal vein （CTPV）. Methods： Twenty-four patients with CTPV underwent 3D-DCE MRA examinations and the reconstructed images were retrospectively analyzed. A series of clinical,laboratory and imaging studies were performed on all these cases. Among all cases 14 underwent operations and 2 with hepatocellular carcinoma complicated portal thrombosis received transhepatic artery chemoembolization. Results： The CTPA was located in the main trunk in 10 cases,in both the main trunk and left/right branches in 8,and in left or right branches of the portal vein in 4. In the remaining 2 cases CTPA was located at the level of superior mesenteric vein. MRA revealed multiple circuitous collateral veins striding over obstruction to extend into the liver in 9 cases ,and in 7 it simultaneously showed streaky or dot-like low signal intensities representing thrombi in the extensively dilated network of portal system. MRA did not clearly demonstrate the structure of the portal vein but only showed multiple sinuous network of venous collaterals strangling together in 6 cases. In 15 cases it also showed the route and distribution of multiple hepatofugal venous collaterals. Conclusion. 3D-DCE MRA can provide adequate information about the site and severity of CTPA.

关 键 词：血管瘤 海绵状/诊断 磁共振血管造影术/方法 成像 三维/方法 回顾性研究 门静脉 海绵样变性 

分 类 号：R445.2[医药卫生—影像医学与核医学]